Role of Anticoagulants for Stroke Prevention in Low-Risk Population Having Atrial Fibrillation and Chronic Kidney Disease: A Systematic Review

Abstract

Over the last few years, there has been a rising incidence of atrial fibrillation and chronic kidney disease cases. Stroke is the major complication seen in such patients. The combination of both diseases makes patient management more tedious.PubMed and Google Scholar underwent screening with keywords and a Medical Subject Heading (MeSH) combination. The words were "atrial fibrillation," "chronic kidney disease/chronic renal insufficiency," "anticoagulation," "efficacy," and "left atrial appendage occlusion."Articles had screening and appraisal. With the English language as a filter, papers from 2002 to 2022 are part of this review. We reviewed studies including male patients with atrial fibrillation and chronic kidney disease under 65 years to see their risk-benefit from anticoagulation. In addition, left atrial appendage occlusion (LAAO) is also compared. A total of eight articles are part of this systematic review.Age plays a more prominent role than gender regarding the impact of drugs on stroke prevention. LAAO also shows a better outcome than oral anticoagulation, provided people agree to undergo surgery. More studies must be done for this target population, especially comparing results with LAAO and oral anticoagulation.

Extracellular Vesicles in Kidney Disease

“…The deterioration of renal damage during liver or heart disease may be caused by EVs, while the advancement of hepatorenal or cardiorenal syndrome may involve EVs [33,34]. Nonvalvular atrial fibrillation is associated with kidney disease because the increase in thromboembolism is mediated by a higher level of EVs from prethrombotic endothelial platelets rather than by thrombotic status and other markers of cell activation, even in anticoagulant patients [35]. In patients with hypertension, the presence of EVs indicating podocyte injury and peritubular capillary injury is detected [36].…”